| Objective(1)Based on the latest consensus standard determined by the Children’s Health Branch of the Chinese Preventive Medical Association,the literature data of cross-sectional studies on the nutritional level of VitD in Chinese children and adolescents in the past decade were analyzed,and the status,influencing factors and temporal and spatial distribution of VitD nutrition in Chinese children and adolescents in the past decade were systematically described.(2)Based on the latest consensus standard of VitD nutrition level,the VitD nutrition level and behavior and lifestyle survey of 3-6 years old preschool children in Qingyang City were conducted to understand and analyze the current situation of VitD nutrition level of local preschool children and its influencing factors,and to provide a basis for guiding local children and children with similar natural and social conditions to scientifically improve VitD nutrition level.Methods(1)CNKI,Wan Fang Data,VIP,The Cochrane Library and Pub Med databases were systematically searched(from January 1,2010 to June 30,2021)to collect literatures on cross-sectional studies of VitD nutrition in Chinese children and adolescents.Based on the latest consensus standard of VitD nutrition level determined by Chinese Children Health Association,this paper systematically analyzed the status,influencing factors and temporal and spatial distribution of VitD nutrition level in Chinese children and adolescents in the past ten years.(2)Preschoolers who underwent physical examination in a community health service center in Qingyang City from August to September 2022 were selected as the study subjects.VitD nutritional level detection,physical examination and behavioral lifestyle questionnaire survey were conducted.Serum 25-(OH)D,alkaline phosphatase(ALP),calcium(Ca)and phosphorus(P)concentrations in blood samples were also detected.SPSS 22.0 software was used for data analysis,basic features were described by component ratio,rates were compared by Chi-Square Test,influence factors were analyzed by binary Logistic regression,and linear correlation was analyzed by Spearman’s correlation.Results(1)A total of 283 articles on VitD nutrition of healthy Chinese children and adolescents were initially retrieved from the electronic database.After discussion and screening consultation,231 articles were finally included,with a total sample size of607,515 people.Among the 231 included articles,there was no statistical heterogeneity between the judgment criteria and detection methods of VitD nutritional level and the mean VitD nutritional level and combined insufficiency rate(all P>0.05).Among them,142 articles from the American Endocrine Society,44 articles from the American Academy of Pediatrics,11 articles from the National Osteoporosis Society of the United States and 34 articles that did not specify the criteria for evaluating the current nutritional level of VitD in children and adolescents.There were 59 chromatographic and 172 immunoassay methods for the determination of VitD nutritional level in children and adolescents.(2)Literature reporting factors affecting VitD nutrition level in children and adolescents are as follows: there were 192 articles on gender factors,among which 56articles(36.84%)on VitD nutritional level and 83 articles(74.11%)on insufficient rate of children and adolescents showed that there were statistically significant differences between different genders.There were 212 age factors,among which 183articles(95.31%)on VitD nutrition level and 147 articles(92.45%)on insufficient rate of children and adolescents showed that there were statistically significant differences between different age groups.There were 24 articles on nutritional status,among which 18 articles(94.74%)on VitD nutritional level and 11 articles(73.33%)on insufficient rate of children and adolescents showed that there were statistically significant differences in different nutritional status.There were 80 articles on seasonal factors,among which 70 articles(97.22%)on VitD nutritional level and 59articles(93.65%)on VitD insufficiency rate in children and adolescents showed that the differences in VitD nutritional level in different seasons were statistically significant.There were 15 articles on the factors of outdoor activity time,among which 9 articles(90.00%)on the level of VitD nutrition and 6 articles(75.00%)on the insufficiency rate of children and adolescents.The differences were statistically significant under different outdoor activity time.There were 11 articles on feeding mode factors,among which 6 articles(85.71%)on VitD nutritional level and 3 articles(75.00%)on insufficient rate of children and adolescents,indicating that there were statistically significant differences between different feeding modes.(3)After the integration and conversion of the included literature,the average VitD nutrition level of 607,515 children and adolescents was 27.94 ng/m L,and the overall insufficient rate was 18.57% according to the latest consensus standard of the existing Child Health branch.There were statistically significant differences in VitD nutrition level among children and adolescents at different ages,feeding methods,nutritional status,seasons and outdoor activity time(all P < 0.05).There were statistically significant differences in the combined rate of VitD nutrient level among children and adolescents with different genders,ages,feeding methods,nutritional status,seasons and different outdoor activity time(all P<0.05).(4)A total of 30 provinces,municipalities and autonomous regions were included in the literature on VitD nutrition level of children and adolescents in different regions.The data showed that the combined VitD nutrition level of children and adolescents in different regions decreased during 2010-2021,and the combined insufficient rate gradually increased.Regional characteristics are shown in: The mean VitD nutritional level of Chinese children and adolescents was the lowest in Xinjiang(19.99 ng/m L),and the highest in Guangxi(36.87 ng/m L).The combined insufficient rate of VitD nutritional level was the highest in Xinjiang(78.00%)and the lowest in Shanghai(3.52%).There were statistically significant differences in the mean VitD nutritional level and combined insufficient rate of children and adolescents in all regions of China(P<0.05).Taking Qinling Mountains and Huaihe River as the boundary,the mean VitD nutrition levels of children and adolescents in southern and northern China were 30.14 ng/m L and 27.31 ng/m L,and the combined insufficient rates were 20.74%and 34.74%,respectively.There were statistically significant differences between the mean VitD nutrition levels and the combined insufficient rates of children and adolescents in southern and northern China(P<0.05).There were also significant differences in the mean VitD nutrition level and combined insufficient rate of children and adolescents in seven geographical regions(Central China,Northeast China,Northwest China,North China,Southwest China,East China and South China)and five climatic regions(temperate continental monsoon,temperate monsoon,subtropical monsoon,tropical monsoon,plateau and alpine climate)divided by climate types(P<0.05),the mean VitD nutrient level in children and adolescents was the highest in South China(31.68 ng/m L)and the lowest in Central China(24.13ng/m L).The combined insufficient rate of VitD nutrient level was the highest in North China(42.77%)and the lowest in South China(12.60%).The mean VitD nutrient level was the lowest in plateau and alpine climate(20.52 ng/m L)and the highest in tropical monsoon climate(29.82 ng/m L).(5)The causes of regional differences in VitD nutrition level of Chinese children and adolescents showed that with the increase of sunshine hours and children’s outdoor activities in some areas,the mean VitD nutrition level showed a decreasing trend,and the combined insufficient rate gradually increased.(6)The results showed that the average VitD nutritional level of 251 children in Qingyang City was 26.46 ng/m L(range: 12.10～42.89 ng/m L),and the rate of VitD nutritional deficiency was 21.12%.There were statistically significant differences between children with normal VitD nutrition level and children with insufficient VitD nutrition level in age,parental education and sunscreen use(all P<0.05).The results of binary Logistic regression analysis on the influencing factors of VitD nutrition level showed that the 5-year old group(OR: 21.162,95%CI: 3.968～112.854)and the6-year old group(OR: 32.222,95%CI: 5.772～179.878),use of sunscreen 3 to 5 times per week(OR: 3.916,95%CI: 1.156～13.271),and never use of sunscreen(OR:17.523,95%CI: 5.284～58.107)were risk factors for insufficient VitD levels.Serum ALP,Ca and P levels were significantly different among groups with different VitD nutrient levels(t=1114.477,281.530,201.838,all P<0.05),and serum ALP,Ca and P levels in normal VitD nutrient level group were higher than those in insufficient VitD nutrient level group.The difference was statistically significant(all P<0.05).Pearson correlation analysis showed that serum Ca and P levels were positively correlated with VitD nutrition levels(r=0.218,0.279,all P<0.05),but serum ALP was not correlated with VitD nutrition levels(P>0.05).Conclusions(1)In the absence of uniform nutritional criteria for VitD in children and adolescents,the most selected criteria were those recommended by the Endocrine Society of America,and the least selected criteria were those recommended by the National Osteoporosis Society of America;In the literature on the detection methods of VitD nutritional level in children and adolescents,the number of literatures using chromatography was less than that using immunoassay.According to the latest consensus standard of the Child Health Care Branch,the overall rate of VitD nutrition deficiency in Chinese children and adolescents is high,especially in high age group,single feeding style,obesity,lack of outdoor activities,and children and adolescents in Xinjiang,Qinghai and other areas,should advocate reasonable diet and adequate outdoor activities.Children and adolescents in plateau and alpine climate areas and areas with fewer sunshine hours should properly supplement VitD.(2)The VitD nutritional level of 3-6 years old preschool children in Qingyang City is slightly lower than the average VitD nutritional level of all Chinese preschool children in the first part of this study,and slightly higher than the average VitD nutritional level of all children and adolescents in Gansu Province in the first part of this study.Compared with the VitD nutritional level of children and adolescents in other parts of China,This result is in the middle.In this area,preschool children aged3-6 years old and those who use sunscreen are the main groups with low VitD nutrition level.It is necessary to strengthen the publicity and education of VitD knowledge to parents and kindergarten teachers and encourage pregnant and pregnant women to supplement VitD appropriately.At the same time do a good job of children’s scientific diet and appropriate increase girls,overweight and obese children and children of high age outdoor exercise. |
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